Advanced practice providers, such as nurse practitioners and physician assistants, play a unique role in the care and treatment of patients. These providers see, treat, and consult with patients, many times expanding the level and types of care available to patients, especially in rural communities. Nebraska law encourages the use of advanced practice providers for efficiency and to expand care to areas where medical care may be limited.
Nebraska law defines the scope of practice for advanced practice providers. Nurse practitioners are required to complete 2,000 collaborative hours under a transition to practice agreement where they work in conjunction with a physician. After the 2,000 hours are completed, nurse practitioners require no physician supervision and can practice independently. On the other hand, physician assistants must perform under the supervision of a licensed physician pursuant to a practice agreement. The law does not favor one type of advanced practice provider over another. Rather, it simply differentiates the two types of providers, among others, upon the level of supervision the practitioner must have by a physician.
Because of the differing supervision requirements, physicians may question whether they are liable for an advanced practice provider’s negligence in the event a lawsuit is filed. While there is no clear line establishing liability, Nebraska does have a statutory provision that states a supervising physician is liable for the negligence of the physician assistants she supervises. See Neb. Rev. Stat. § 38-2053. There is no similar provision for nurse practitioners, but this does not mean that a physician could not be held liable for the negligence of his nurse practitioner. As many physicians are aware, anytime there is interaction with a patient, there is malpractice exposure.
Physicians and advanced practice providers should not change their practice or have added stress over the legal definitions of these relationships. The law favors collaboration, and it is vital to have open and continued conversations about what collaborative practices look like to each physician-advanced practice provider relationship. If a physician is supervising an advanced practice provider in Nebraska, he does not need to see every patient with the provider or document a review on every chart. However, if that physician does collaborate with an advanced practice provider or participate in the care of the patient, be sure to document accordingly. In medical malpractice cases, the best piece of evidence to have is a contemporaneous medical record. If the physician was not in the room with the advanced practice provider, he should not document he was. If the physician only reviewed the chart and agreed with findings, his note should document that level of care. The key is to be reasonable and clear in documentation as to the role a physician played in the care of the patient.
In short, the primary focus for both advanced practice providers and physicians should be providing practical and collaborative medical care, not liability exposure. Following individual institutions’ guidance on how this collaborative relationship should operate and thorough documentation are examples of best practices to foster and guide this relationship. The current trend in medical malpractice suits is to sue the entity, not the specific provider. Rather than placing blame on one provider versus another, developing a clear understanding of the collaborative relationship between providers fosters expanding medical care while keeping the best interests of the patient in mind.